Exploratory analysis of the relationships of sleep disorders, emotional symptoms and blood inflammatory markers with suicidal ideation in major depressive disorder.
Jul 2026· Journal of Affective Disorders· Vol 413, pp.
122278
· 0 citations· 47 references
Medicine
TL;DR
Sleep disorders, inflammatory dysregulation, and anxiety symptoms constitute an interconnected network associated with SI in MDD, and the importance of comprehensive, integrated interventions is highlighted.
Abstract
Background
Suicidal ideation (SI) represents a severe consequence of major depressive disorder (MDD). While sleep disorders and immune dysregulation are associated with SI, the precise associations and complex mediating pathways involving sleep disturbances, inflammatory biomarkers, and anxiety and depression severity remain poorly understood.
Methods
A total of 157 patients suffering from MDD were enrolled. Based on Item 3 of the 17-item Hamilton Depression Rating Scale (HAMD), participants were categorized into SI and non-suicidal ideation (NSI) groups. Sleep disorders were assessed using the Pittsburgh Sleep Quality Index (PSQI). Peripheral inflammatory markers were from complete blood counts. Spearman correlation analysis and multiple logistic regression methods were employed to analyze the associations of sleep disorders, emotional symptoms, and inflammatory markers with SI. Additionally, a bidirectional mediation analysis was conducted to explore the association of these variables with SI.
Results
Patients with SI exhibited poorer sleep quality and altered inflammatory profiles. Significant correlations were observed among affective symptoms, sleep measures, and immune markers. The results showed that in models excluding emotional symptoms, the global PSQI score and sleep disturbances component were associated with SI. Mediation analysis indicates that the percentage of lymphocytes was indirectly associated with SI via the sleep disturbances and daytime dysfunction components. The daytime dysfunction component and HAMA score were associated with SI through bidirectional mediating pathways.
Conclusions
Sleep disorders, inflammatory dysregulation, and anxiety symptoms constitute an interconnected network associated with SI in MDD. These findings highlight the importance of comprehensive, integrated interventions.
BACKGROUND
Depressive and anxiety symptoms (depression and anxiety hereafter), and suicidality are common among psychiatric patients. This study examined the network structure of depressive and anxiety symptoms and suicidality among psychiatric patients across Asia.
METHODS
Data were drawn from the Research on Asian Psychotropic Prescription Patterns for Antidepressants Phase 3 study (REAP-AD3), which included 2,455 psychiatric patients from 11 Asian countries and territories. Depression and anxiety were assessed using the 9-item Patient Health Questionnaire (PHQ-9) and 7-item Generalized Anxiety Disorder Scale (GAD-7), respectively, while suicidality (i.e., suicidal thoughts or acts) was assessed by a clinical interview. Expected Influence (EI) and Bridge EI were used as centrality indices in the symptom network to characterize the structure of the symptoms.
RESULTS
The point prevalence of suicidality was 30.1% (95% confidence interval [CI] = 28.2, 31.9) among the psychiatric patients. The network analysis identified PHQ2 ("Sad mood") as the most central symptom, followed by GAD2 ("Uncontrollable worry"). Additionally, PHQ8 ("Motor disturbances") and S ("Suicidality") were identified as bridge nodes linking depression and anxiety with suicidality. The flow network indicated that PHQ6 ("Guilt") and PHQ2 ("Sad mood") had the strongest positive associations with suicidality.
CONCLUSIONS
Suicidality was common among psychiatric patients across Asia. The central and bridge symptoms might represent potential clinical markers and generate hypotheses for longitudinal and interventional research on depression, anxiety, and suicidality in the future.
L. A, Yuan Feng, Qinge Zhang et al.· International Journal of Soc...· 0 citations
Background Adolescent major depressive disorder (MDD) is clinically heterogeneous, with sleep disturbance often emerging as a prominent but variably expressed symptom dimension. This study aimed to identify latent symptom profiles in drug‐naïve adolescents with MDD and examine their associations with recorded trauma/stressor exposure and neuroendocrine markers. Methods This cross‐sectional study included 711 drug‐naïve adolescents with MDD. Latent profile analysis (LPA) was conducted using 16 symptom indicators derived from the Hamilton depression rating scale (HDRS), Hamilton anxiety rating scale (HAMA), and Pittsburgh sleep quality index (PSQI). Multinomial logistic regression examined associations of recorded trauma/stressor exposure and neuroendocrine markers with profile membership. Results A three‐profile solution was retained: low overall symptoms (Profile 1; n = 200, 28.1%), PSQI‐elevated subjective sleep disturbance (Profile 2; n = 215, 30.2%), and high overall symptoms (Profile 3; n = 296, 41.6%). Recorded family trauma/stressor exposure and violent incident exposure were associated with higher odds of Profile 3 membership relative to Profile 1, and these associations remained significant after neuroendocrine markers were added. Higher standardized testosterone (T) showed a modest association with Profile 3 membership, whereas FT3 showed only a marginal association. However, adding neuroendocrine markers did not significantly improve model fit beyond trauma‐related variables. Conclusion LPA identified three clinically interpretable symptom profiles in adolescent MDD, including a profile characterized primarily by elevated PSQI‐assessed subjective sleep disturbance. Recorded trauma/stressor exposure was associated with the high overall symptom profile, whereas neuroendocrine markers showed limited incremental value. These findings highlight multidimensional symptom profiling and trauma assessment in adolescent depression, while suggesting that neuroendocrine findings should be considered exploratory.
Jianyu Liu, Xin Cao, Meng Yang et al.· Depression and Anxiety· 0 citations
Background: Fibromyalgia (FM) is a complex chronic pain disorder characterized by interactions among psychological, biological, and clinical factors. Although psychiatric symptoms and sleep disturbance are recognized contributors to disease burden, their multidimensional relationships with selected biological variables and fibromyalgia severity remain incompletely understood. Objective: This study aimed to investigate multidimensional associations among psychiatric symptoms, sleep disturbance, selected biological variables, and fibromyalgia severity using complementary analytical approaches, including multiple linear regression, Classification and Regression Tree (CART) analysis, and path analysis. Methods: In this cross-sectional study, 102 women with FM and 53 healthy female controls underwent standardized clinical and laboratory assessment. Fibromyalgia severity was assessed using the Fibromyalgia Impact Questionnaire (FIQ), depressive symptoms with the Beck Depression Inventory (BDI), anxiety symptoms with the Beck Anxiety Inventory (BAI), and sleep disturbance with the Jenkins Sleep Scale (JSS). Serum thyroid-stimulating hormone (TSH) and 25-hydroxyvitamin D concentrations were measured as selected biological variables. Multiple linear regression identified independent associations with disease severity, CART analysis evaluated hierarchical classification patterns, and path analysis examined direct and indirect associations within a predefined conceptual framework. Results: Depressive symptoms, sleep disturbance, and anxiety symptoms were independently associated with greater fibromyalgia severity, whereas TSH and vitamin D showed no consistent independent associations. CART identified sleep disturbance as the primary hierarchical classifier, followed by depressive and anxiety symptoms, achieving an overall classification accuracy of 93.5% (AUC = 0.951). Within the proposed conceptual framework, path analysis demonstrated direct associations between psychological symptoms and fibromyalgia severity, whereas TSH and vitamin D exhibited distinct indirect relationships through depressive and anxiety symptoms, respectively. Conclusions: Psychological symptoms were more consistently associated with fibromyalgia severity than the selected biological variables across complementary analytical approaches. The integrated use of multiple linear regression, CART analysis, and path analysis provided a multidimensional perspective on fibromyalgia and highlighted the importance of comprehensive biopsychosocial assessment while emphasizing that the observed findings represent statistical associations rather than causal relationships.
S. Akan, Mustafa Uğurlu, Bahadır Ertürk· Journal of Clinical Medicine· 0 citations
BACKGROUND
Suicidal ideation (SI) is an emotional symptom of major depressive disorder (MDD) that significantly impacts the quality of life of affected individuals. The relationship between inflammation and suicide is both complex and bidirectional. Neuroinflammation has been increasingly implicated in the pathophysiology of depression and SI. Toll-like receptors (TLRs) trigger Nuclear Factor Kappa B (NF-κB) activation, initiating immune responses and inflammation when they recognize pathogens or danger signals.
OBJECTIVE
This study aimed to investigate the relationship between NF-κB expression levels and symptoms, SI in depressive patients.
METHODS
This case-control study included 60 patients diagnosed with MDD. Based on clinical assessment, Beck Depression Inventory-II (BDI-II), and Hamilton Depression Rating Scale (HDRS) scores, participants were stratified into three subgroups: 20 individuals with recent SI within the past month, 20 with a past history of SI but no such thoughts in the last month, and 20 with no history of SI, serving as the control group. Blood levels of NF-κB were measured using a Human NF-κB enzyme-linked immunosorbent assay (ELISA)Kit.
RESULTS
A weak, inverse association was observed between patients with a history of SI and NF-κB levels compared to patients without a history of SI.
CONCLUSIONS
The findings of the present study suggest that depressed patients with SI may have impaired expression of NF-κB. A decrease in blood levels of NF-κB, among other influencing factors, could serve as a potential predictor of SI in patients with MDD.
Kimia Sarmast, Mahdieh Rahmani, Reza Rostami et al.· Discover Mental Health· 0 citations
Opioid Use Disorder (OUD) carries a high risk of psychiatric comorbidities, such as depression, sleep disturbances and suicidal behaviour. Recent findings emphasise the impact of chronotype and biological rhythm disturbances on the severity of addiction and suicidality. This study examined the associations between chronotype, biological rhythm characteristics, sleep quality, depressive symptoms and suicidal behaviour in individuals with OUD. A total of 159 patients diagnosed with OUD and 154 healthy controls were evaluated using validated scales, including the Columbia Suicide Severity Rating Scale, Biological Rhythm Assessment Interview, Morningness-Eveningness Questionnaire, Pittsburgh Sleep Quality Index, Beck Depression Inventory and Addiction Profile Index. The results showed that individuals with OUD had significantly higher rates of suicidal ideation and attempts, poorer sleep quality, more irregular biological rhythms and more severe depressive symptoms than the control group. An evening chronotype was more prevalent in the OUD group and was associated with greater addiction severity, disrupted rhythms, poor sleep quality, and increased suicidality. Higher depression severity was significantly associated with lower morningness preferences, and sleep quality was found to explain a significant portion of the shared variance between depressive symptoms and suicidal outcomes. These findings suggest that assessing chronotype and circadian dysregulation could help to identify high-risk patients and inform the development of targeted interventions to improve outcomes in OUD treatment.
Meryem Topal, M. Ergelen· Chronobiology International· 0 citations
High BMI correlates with more severe depressive symptoms and increased inflammatory status in adolescents with MDD, especially among females, suggesting that interventions targeting immune and metabolic pathways may offer additional therapeutic benefits.
Ding Yang, Jialu Jiang, Yuan Gao et al.· Journal of Affective Disorde...· 0 citations
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